Creating a bowel management plan for pediatric orthopaedic spine surgery patients.

Purpose: Opioid-induced constipation is a common problem in patients who have undergone surgery. No standard gastrointestinal protocol exists to manage perioperative care in pediatric orthopaedic spinal fusion patients despite data which support the need for a bowel regimen while a patient is taking narcotics. At our institution, this group of patients often present to the emergency department with constipation and other gastrointestinal complaints. We developed a quality improvement initiative to create a standardized bowel management plan for pediatric patients undergoing orthopaedic spine surgery to decrease constipation, thus improving care, and minimizing unplanned visits.

Methods: We developed a bowel management plan in collaboration with the gastroenterology team, created an Epic Smart Phrase for discharge instructions to enhance compliance, and created and dispersed informational communication on changes to constipation management. We monitored compliance, emergency department visits, and re-admissions.

Results: Compliance with the bowel management plan, including inpatient medication prescribing and discharge "at-home" education, has increased to a mean of 93%. Emergency Department (ED) visits or re-admissions for constipation were reduced from a baseline mean of 1 in every 11 cases, to 1 in every 184 cases. Our institution sustained more than 2 years without an ED visit or readmission related to constipation in this patient population after the bowel management plan was in place.

Conclusion: A bowel management plan can be used in the care of pediatric spinal fusion patients to increase patient safety, decrease healthcare burden, and improve care. This project not only increased awareness of post-surgical gastrointestinal symptoms and opioid side effects, but also decreased post-operative emergency department visits and re-admissions related to constipation.

Level Of Evidence: III, case control study.